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Johnstone, Mark S. and McSorley, Steven T. and McMillan, Donald C. and Horgan, Paul G. and Mansouri, David (2024) The relationship between systemic inflammatory response, screen detection and outcome in colorectal cancer. Colorectal Disease, 26 (1). pp. 81-94. ISSN 1462-8910

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Abstract

Aim:
A raised systemic inflammatory response correlates with poorer colorectal cancer (CRC) outcomes. Faecal immunochemical test bowel screening aims to detect early-stage disease. We assessed the relationship between systemic inflammatory response, screen detection and CRC survival.

Method:
A retrospective, observational cohort study compared screen-detected and non-screen-detected CRC patients undergoing resection. Systemic inflammatory response was measured using lymphocyte/monocyte, neutrophil/lymphocyte and platelet/lymphocyte ratios (LMR, NLR, PLR). Covariables were compared using χ2 testing and survival with Cox regression.

Results:
A total of 761 patients were included (326 screen-detected, 435 non-screen-detected). Screen-detected patients had lower systemic inflammatory response: low (<2.4) LMR (28.8% vs. 44.6%; P < 0.001), moderate (3–5) or high (>5) NLR (26.1% vs. 30.6%, P < 0.001; and 7.7% vs. 19.5%, P < 0.001) and high (>150) PLR (47.2% vs. 64.6%; P < 0.001). Median follow-up was 63 months. On univariate analysis, non-screen detection (hazard ratio [HR] 2.346, 95% CI 1.687–3.261; P < 0.001), advanced TNM (P < 0.001), low LMR (HR 2.038, 95% CI 1.514–2.742; P < 0.001), moderate NLR (HR 1.588, 95% CI 1.128–2.235; P = 0.008), high NLR (HR 2.382, 95% CI 1.626–3.491; P < 0.001) and high PLR (HR 1.827, 95% CI 1.326–2.519; P < 0.001) predicted poorer overall survival (OS). Non-screen detection (HR 2.713, 95% CI 1.742–4.226; P < 0.001), TNM (P < 0.001), low LMR (HR 1.969, 95% CI 1.340–2.893; P < 0.001), high NLR (HR 2.368, 95% CI 1.448–3.875; P < 0.001) and high PLR (HR 2.110, 95% CI 1.374–3.240; P < 0.001) predicted poorer cancer-specific survival (CSS). On multivariate analysis, non-screen detection (HR 1.698, 95% CI 1.152–2.503; P = 0.008) and low LMR (HR 1.610, 95% CI 1.158–2.238; P = 0.005) independently predicted poorer OS. Non-screen detection (HR 1.847, 95% CI 1.144–2.983; P = 0.012) and high PLR (HR 1.578, 95% CI 1.018–2.444; P = 0.041) predicted poorer CSS.

Conclusion:
Screen-detected CRC patients have a lower systemic inflammatory response. Non-screen detection and systemic inflammatory response (measured by LMR and PLR respectively) were independent predictors of poorer OS and CSS.

People

Johnstone, Mark S.

Author

Publications

Johnstone, Mark S. and McSorley, Stephen T. and McMahon, Andrew J. (2023) Management of malignant T1 colorectal cancer polyps: results from a 10-year prospective observational study. Colorectal Disease, 25 (10). pp. 1960-1972. ISSN 1462-8910

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McSorley, Steven T.

Author

Publications

Dolan, Ross D. and Pennel, Kathryn and Thompson, Joshua and McKenzie, Molly and Alexander, Peter and Richards, Colin and Black, Douglas and Abbass, Tanvir and Maka, Noori and McGovern, Josh and Roseweir, Antonia and McSorley, Stephen T. and Horgan, Paul G. and Roxburgh, Campbell and McMillan, Donald C. and Edwards, Joanne (2025) The relationship between tumour necrosis, systemic inflammation, body composition and survival in patients with colon cancer. BJC Reports, 3 (1): 7. ISSN 2731-9377

Ingham, Abigail R. and McSorley, Stephen T. and McMillan, Donald C. and Chong, David and Mackay, Graham J. and Wrobel, Aleksandra and Kong, Chia Yew and Alani, Ahmed and Nicholson, Gary and Roxburgh, Campbell S.D. (2025) Does robotic assisted surgery mitigate obesity related systemic inflammatory response and clinical outcomes in left sided colorectal cancer resections? Journal of Robotic Surgery, 19 (1): 98. ISSN 1863-2483

Brown, Leo R. and Thomson, Georgina G. and Gardner, Ellen and Chien, Siobhan and McGovern, Josh and Dolan, Ross D. and McSorley, Stephen T. and Forshaw, Matthew J. and McMillan, Donald C. and Wigmore, Stephen J. and Crumley, AndrewB. and Skipworth, Richard J.E. (2024) Cachexia index for prognostication in surgical patients with locally advanced oesophageal or gastric cancer: multicentre cohort study. British Journal of Surgery, 111 (4): znae098. ISSN 0007-1323

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McMillan, D.C.

Author

Publications

Bradley, Nicholas A. and Walter, Amy and Sankey, Chiara and Wilson, Alasdair and Siddiqui, Tamim and Roxburgh, Campbell D. and McMillan, Donald C. and Guthrie, Graeme J.K. (2025) Longitudinal association between statins and changes in CT derived body composition in patients with abdominal aortic aneurysm. Journal of Cachexia, Sarcopenia and Muscle, 16 (2). ISSN 2190-5991

Thompson, Joshua J. and MacLeod, Nicholas and Will, Sarah and O'Rourke, Fraser and McGovern, Josh and Roxburgh, Campbell and Edwards, Joanne and Dolan, Ross D. and McMillan, Donald C. (2025) The prognostic value of a laboratory cachexia score (LCAS) defined by LDH, CRP and albumin in patients with advanced lung cancer. BMC Cancer, 25: 543. ISSN 1471-2407

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Horgan, Paul S.

Author

Publications

Galbraith, Norman J. and Quinn, Jean A. and Al-Badran, Sara Sf and Pennel, Kathryn A.F. and Hillson, Lily V.S. and Hatthakarnkul, Phimmada and McKenzie, Molly and Maka, Noori and Loi, Lynette and Frixou, Mikaela and Steele, Colin W. and Roxburgh, Campbell S. and Horgan, Paul G. and McMillan, Donald C. and Edwards, Joanne (2024) TAK1 expression is associated with increased PD-L1 and decreased cancer-specific survival in microsatellite-stable colorectal cancer. Translational Oncology, 48: 102064. ISSN 1944-7124

Golder, Allan M. and Ferguson, Michael and McMillan, Paul and Mansouri, David and Horgan, Paul G. and Roxburgh, Campbell S. and Dolan, Ross D. and McGovern, Josh and McMillan, Donald (2024) CT-derived body composition and differential association with age, TNM stage and systemic inflammation in patients with colon cancer. Scientific Reports, 14: 15673. ISSN 2045-2322

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